Circular stapled mucosectomy (CSM) is an alternative option for surgical treatment of symptomatic hemorrhoids. Results, showed in recent papers, are good; however incidents of fecal urgency, a well as other complications were also reported.Our study is a prospective analysis of CSM results in treatment of hemorrhoids in 5 years follow-up.
Method: 50 patients, who underwent CSM between 07.2000 and 06.2001 were included into the trial. 5 (10%) patients had preoperatively II° hemorrhoids, 34 (68%) III° and 11 (22%) IV°. All patients complained of frequent proctorrhagia. 15 (30%) had anal soiling, 14 (28%) had pruritus of the anus and 1 patient (with IV° hemorrhoids) reported incidents of occasional liquid feces incontinence.Patients with concomitant hemorrhoidal thrombosis, anal fissure and with history of proctologic procedures were excluded.22 (44%) procedures were performed in spinal, 28 (56%) in short intravenous anaesthesia. All procedures were done by trained colorectal surgeons (over 20 CSM done before trial).
Results: Mean procedure time was 30,4 (14,1- 63,3) minutes.Mean postoperative hospital stay time was 2,1 (1-5) days. During surgery, in 5 (10%) cases, submucosal haematoma was noted; in 25(50%) cases additional hemostasis due to stapling line bleeding was required.In post-op period 1 patient required surgery (haemostatic suture on stapling line) due to prolonged rectal bleeding. No other complications were noted in post-op period.Postoperative pain was measured with VAS scale (0-no pain; 10 - worst possible pain).Mean VAS pain score at 1 post-op day was 1,83 (0,0 - 7,2, SD=1,79).3 months after surgery 47 (94%) patients had no symptoms of hemorrhoids (bleeding, prolapse).3 (6%) had infrequent anal bleeding, 1 (2%) patient reported frequent anal bleeding. Patient was qualified for surgery (Milligan-Morgan procedure).No fecal incontinence incidents were noted. 1 (2%) patient had transient fecal urgency.Patient satisfaction was measured with VAS scale (0- not satisfied at all, 10 - fully satisfied). Mean score was 9,6 (6,4 - 10,0, SD=0,82).Consecutive follow-up visits were performed annually.Five years after surgery 43 (87,7%) patients were symptoms-free, 6 (12,3%) patients had infrequent anal bleedings, of which 3 (50%) required symptomatic, topical treatment. No other hemorrhoids symptoms or fecal incontinence were noted. All patients were free of fecal urgency. VAS satisfaction score was 9,3 (6,3-10,0, SD=0,72)
Conclusions: Long term results of CSM are good. In our series no serious complications in short and long term period were noted. Patients were overall satisfied with treatment results.